Provider Demographics
NPI:1396760963
Name:PENNINGTON RADIOLOGY ASSOCIATES LLC
Entity type:Organization
Organization Name:PENNINGTON RADIOLOGY ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:W
Authorized Official - Last Name:RUBINOFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-365-4456
Mailing Address - Street 1:PO BOX 299
Mailing Address - Street 2:
Mailing Address - City:EMERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07630-0299
Mailing Address - Country:US
Mailing Address - Phone:973-365-4450
Mailing Address - Fax:973-916-2033
Practice Address - Street 1:350 BOULEVARD
Practice Address - Street 2:
Practice Address - City:PASSAIC
Practice Address - State:NJ
Practice Address - Zip Code:07055-2840
Practice Address - Country:US
Practice Address - Phone:973-365-4450
Practice Address - Fax:973-916-2033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0055379Medicaid
NJ088341Medicare ID - Type Unspecified